ABSTRACT
ABSTRACT We report on the management of three cases of rectal stump leak and sepsis following urgent Hartmann's procedure for perforated sigmoid diverticulitis or large bowel obstruction. Two patients had significant risk factors for poor tissue healing. All patients developed features of sepsis and computer tomography scans demonstrated rectal stump leak with adjacent collections. All patients required reoperation for drainage and washout of abscess. An intraperitoneal catheter system was introduced together with drains in order to continue on the ward until tract was formed. There was no mortality and minimal morbidity. The key to management of rectal stump leak is the early and aggressive drainage of the associated collection and continued irrigation of the stump.
RESUMO Relatamos o tratamento de três casos de vazamento de coto retal e sepse após o procedimento de urgente de Hartmann para diverticulite sigmoide perfurada ou obstrução do intestino grosso. Dois pacientes apresentaram fatores de risco significativos para uma má cicatrização tecidual. Todos os pacientes desenvolveram características de sepse e tomografia computadorizada demonstraram vazamento de coto retal com coleções adjacentes. Todos os pacientes necessitaram de reoperação para drenagem e lavagem do abscesso. Um sistema de cateter intraperitoneal foi introduzido junto com os drenos para continuar na enfermaria até a formação do trato. Não houve mortalidade e morbidade mínima. A chave para o gerenciamento do vazamento de coto retal é a drenagem precoce e agressiva da coleta associada e a irrigação contínua do coto.
Subject(s)
Humans , Male , Aged , Sigmoid Diseases/pathology , Diverticulitis, Colonic/pathology , Proctectomy/adverse effects , Postoperative Complications , Drainage/methodsABSTRACT
ABSTRACT Acute free perforation of the sigmoid diverticulitis is an emergency surgical intervention required condition. Although the sigmoid resection and temporary end colostomy or abdominal lavage and drainage are the most commonly used surgical methods for its treatment, the most effective surgical method has not been established yet. We applied a different surgical method for the surgical treatment of free perforation of acute sigmoid diverticulitis outside of these surgical procedures. A double row epiploicoplasty was performed for surgical treatment of free perforated sigmoid diverticulitis with surgical success in a patient who had concominant serious diseases.
RESUMO A perfuração livre aguda da diverticulite de sigmoide é um problema que exige intervenção cirúrgica de emergência. Embora a ressecção de sigmoide e a colostomia de extremidade temporária ou a lavagem e drenagem abdominal sejam os métodos cirúrgicos mais comumente utilizados para o seu tratamento, o método cirúrgico mais eficaz ainda não foi estabelecido. Aplicamos um método cirúrgico diferente para o tratamento cirúrgico de perfuração livre de diverticulite de sigmoide aguda fora desses procedimentos cirúrgicos. Uma epiploicoplastia de duas fileiras foi realizada para o tratamento cirúrgico de diverticulite perfurada livre de sigmoide com sucesso cirúrgico em um paciente com doenças graves concomitantes.
Subject(s)
Humans , Female , Diverticulitis, Colonic/surgery , Diverticulitis, Colonic/pathology , Colon, Sigmoid , General Surgery/methods , Colonic Diseases , Intestinal PerforationSubject(s)
Humans , Female , Aged , Diabetes Mellitus, Type 1/pathology , Hypertension/pathology , Stroke/pathology , Arteriosclerosis/complications , Arteriosclerosis/pathology , Diabetes Mellitus, Type 1/complications , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/pathology , Fatal Outcome , Hypertension/complications , Liver Cirrhosis/complications , Liver Cirrhosis/pathology , Stroke/complicationsABSTRACT
A case of intestinal angiocentric T/NK-cell lymphoma in a 58-year-old man is reported. The patient presented initially with panperitonitis because of perforation of sigmoid colon diverticulum. He underwent segmentectomy of involved bowel. Histologically, the intestinal wall showed diffuse infiltration of medium or large size lymphoma cells with angiocentric growth and necrosis. The lymphoma cells were CD56+, CD45RO+, CD3+, CD4-, CD8-, CD20-, and CD30- in paraffin sections with germline configuration of TCR-gamma gene, consistent with T/NK-cell lymphoma. Further staging revealed splenomegaly. Intestinal angiocentric T/NK cell lymphoma represents a distinct etiology of diverticulum with perforation.
Subject(s)
Humans , Male , CD56 Antigen/analysis , Colon/pathology , Colonic Neoplasms/diagnostic imaging , Colonic Neoplasms/pathology , DNA, Neoplasm/analysis , Diagnosis, Differential , Diverticulitis, Colonic/diagnostic imaging , Diverticulitis, Colonic/pathology , Immunoglobulin Heavy Chains/genetics , Killer Cells, Natural/pathology , Killer Cells, Natural/chemistry , Lymphoma, T-Cell/pathology , Lymphoma, T-Cell/chemistry , Middle Aged , Necrosis , Peritonitis/diagnostic imaging , Peritonitis/pathology , Receptors, Antigen, T-Cell/genetics , Tomography, X-Ray ComputedABSTRACT
Se analizaron retrospectivamente las historias clínicas de 58 pacientes operados por diversas complicaciones de la enfermedad diverticular del colon en el Hospital Español de Buenos Aires entre junio de 1975 y junio de 1987. Eran 33 mujeres y 25 hombres con edad promedio de 69 años. Se correlacionó la clínica y la patología. En el 24 por ciento de los pacientes los cuadros clínicos de tipo inflamatorio no tuvieron correlación histopatológica. Los enfermos resecados por hemorragia tenían un patrón histológico inflamatorio. La colostomía transversa desfuncionalizante no evita la diverticulitis. El mayor tiempo de colostomía transversa desfuncionalizante no disminuyó el patrón histopatológico inflamatorio, como era de esperar.